Making Democracy Work

Health Care Reform Issues

Summary of remarks by Dr. Randy Marsh July 28, 2009

Current System
  • 60-65% of Americans are in some kind of federally supported and run health care system: Medicare, Medicaid, Veteran's Administration, SCHIP, Federally elected officials' health care system.
  • Money for these programs comes from one source--taxes--and pays from one source.
  • Insurance is the most expensive things we buy in our lifetime.
  • Some states (Massachusetts, Oregon) have tried to create solutions but they haven't been able to control cost.
  • Uninsured are not the center; they are result of the critical problems
  • Three most critical problems in current system:



All are equal
All in one system

COST problem contains this subset of issues:

  • Insurance Companies
  • Practice Inefficiencies (Doctors and Hospitals)
  • Defensive Medicine
  • Drugs and Medical Devices
  • Manpower
  • Individual Responsibility
  • Rationing

1. Insurance Companies
  • Should be independent of government, publicly funded, privately run (Congress will resist this).
  • Simplest solution is to extend Medicare to all with a private, non-profit governing authority.
  • Alternative system: Government delegates insurance to non-profit private companies who compete for business.  More complicated.  Companies must give same policy to everyone.  Companies make money on other types of insurance (house, car, etc.)  Tax money goes toward premium based on a sliding scale, based on income.  Currently, 2/3 of income taxes are paid by the top 10% of population.

2. Practice Inefficiencies
  • Fee for service for doctors needs to be eliminated; currently, doctors paid for quantity of services not quality (If you do more, you make more)
  • Bundled payments needed (examples: Mayo, Cleveland, Kaiser)

3. Defensive Medicine (malpractice insurance problem)
  • Less than .6% of the cost of medical care
  • Hidden costs of malpractice insurance: unnecessary testing
  • Solutions:  Need to change tort law  If one is injured in health care system, cost is paid for from public fund  Make system safer  Re-educate doctors and assess performance

4. Drugs and Medical Devices
  • Create an oversight board that controls costs
  • Bundled payments

5. Lack of Manpower among primary care providers
  • Need to support education for primary care providers
  • Increase numbers of nurse practitioners

6. Personal Responsibility
  • Healthy nutrition, exercise, healthy practices
  • Provide premiums for not smoking, working out, etc.

These ideas are based on the Dutch health care system.